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Aryankhesal A, Blake J, Wong G, Megson M, Briscoe S, Allan L, Broomfield NM, Eastwood Z, Greene L, Hilton A, Killett A, Lazar AS, Litherland R, Livingston G, Maidment I, Reeve J, Rook G, Scott S, Um J, van Horik J, Fox C. Sleep disturbance in people living with dementia or mild cognitive impairment: a realist review of general practice. Br J Gen Pract 2024; 74:e233-e241. [PMID: 38499365 PMCID: PMC10962510 DOI: 10.3399/bjgp.2023.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/23/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Sleep disturbance is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex because of the comorbidities, older age, and cognitive impairment typical of this patient group. AIM To explore how primary care clinicians assess, understand, and manage sleep disturbance for PLwD or MCI; if and why such initiatives work; and how people and their carers experience sleep disturbance and its treatment. DESIGN AND SETTING A realist review of existing literature conducted in 2022. METHOD Six bibliographic databases were searched. Context-mechanism-outcome configurations (CMOCs) were developed and refined. RESULTS In total, 60 records were included from 1869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of sleep disturbance among primary care clinicians and patients, combined with time and resource constraints, meant that identifying sleep disturbance was difficult and not prioritised. Medication was perceived by clinicians and patients as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good-quality sleep. CONCLUSION In primary care, sleep disturbance among PLwD or MCI is not adequately addressed. Over-reliance on medication, underutilisation of non-pharmacological strategies, and inflexible care home routines were reported as a result of low confidence in sleep management and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of sleep disturbance to the needs of individuals and their informal carers without overstretching services.
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Affiliation(s)
- Aidin Aryankhesal
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | - Jessica Blake
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Molly Megson
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull
| | | | | | - Niall M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich
| | - Zenahrai Eastwood
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | | | - Andrea Hilton
- School of Paramedical PeriOperative and Advanced Practice, Faculty of Health Sciences, University of Hull, Hull
| | - Anne Killett
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | - Alpar S Lazar
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | | | - Gill Livingston
- Faculty of Brain Sciences, Division of Psychiatry, University College London, London
| | - Ian Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull
| | | | - Sion Scott
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester
| | - Jinpil Um
- University of Exeter Medical School, Exeter
| | | | - Chris Fox
- University of Exeter Medical School, Exeter
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Doyle C, Bhar S, Bryant C, Dow B, Dunt D, Mnatzaganian G, O'Connor D, Ratcliffe J, You E, Bagnall AM, Major G, Harper R, Fearn M. BEFRIENding for Depression, Anxiety and Social support in older adults living in Australian residential aged care facilities (BEFRIENDAS): randomised controlled trial protocol. BMC Geriatr 2021; 21:305. [PMID: 33980168 PMCID: PMC8115389 DOI: 10.1186/s12877-021-02233-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This protocol describes an ongoing study of the impact of befriending on depression, anxiety and loneliness in older people living in residential aged care facilities in Australia. While systematic reviews of befriending have indicated positive benefits of befriending for people in a range of ages and settings, there have been no randomised controlled trials (RCTs) of befriending for older people living in residential aged care with depression and no studies of the cost effectiveness of befriending in residential aged care facilities (RACFs) in Australia. METHODS AND ANALYSIS We are conducting a single blind pragmatic RCT comparing two groups of older people living in RACFs, one receiving an intervention consisting of weekly befriending for 4 months from a trained volunteer and the other receiving treatment as usual. Participants undergo eligibility screening for depression (GDS-15 ≥ 4) and cognitive impairment (GPCog ≥ 4) and assessments at three measurement time points: baseline prior to randomisation, 2 months post-baseline and 4 months post-baseline. The primary outcome measure is depression, and secondary outcome measures are anxiety, loneliness, social isolation and quality of life. The economic evaluation will take the form of a cost-utility analysis based on the outcome of quality of life. The primary and secondary outcomes will be analysed using negative binomial and logistic regressions utilizing the Generalised Estimating Equations approach. DISCUSSION To our knowledge, this is the first RCT evaluating the effectiveness of befriending on older people with depression living in residential aged care. It is expected that the befriending intervention will reduce the severity of depression symptoms experienced by older people living in residential aged care. If the intervention proves effective it may be incorporated into volunteer training programs and adopted as a way of supporting older people's mental health. TRIAL REGISTRATION Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number: ACTRN12619000676112 , registered 06/05/2019 - retrospectively registered.
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Affiliation(s)
- Colleen Doyle
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia. .,Department of Psychological Sciences, Swinburne University, John Street, Hawthorn, 3122, Australia. .,School of Nursing and Midwifery, Deakin University, Burwood Highway, Burwood, 3125, Australia.
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University, John Street, Hawthorn, 3122, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Grattan Street, Parkville, 3010, Australia
| | - Briony Dow
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia.,School of Nursing and Midwifery, Deakin University, Burwood Highway, Burwood, 3125, Australia.,School of Population and Global Health, The University of Melbourne, Grattan Street, Parkville, 3010, Australia
| | - David Dunt
- School of Population and Global Health, The University of Melbourne, Grattan Street, Parkville, 3010, Australia
| | | | - Daniel O'Connor
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, 3800, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Sturt Road, Bedford Park, 5042, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, The University of Melbourne, Poplar Road, Parkville, 3052, Australia
| | | | - Georgia Major
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia
| | - Robin Harper
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia
| | - Marcia Fearn
- Aged Care Division, National Ageing Research Institute, Poplar Road, Parkville, 3052, Australia
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Kiss N, Giezendanner S, Zeller A. [Geriatric Psychiatry in Nursing Homes in the Canton Basel-Stadt - The View of General Practitioners]. PRAXIS 2021; 110:257-261. [PMID: 33849289 DOI: 10.1024/1661-8157/a003642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Geriatric Psychiatry in Nursing Homes in the Canton Basel-Stadt - The View of General Practitioners Abstract. Background: This cross-sectional study intends to examine the potential need for an outpatient geronto-psychiatric service and evaluates GPs' views of the frequency of psychiatric symptoms among residents of nursing homes in the canton of Basel-Stadt, Switzerland. Results: Nine out of ten (89 %) see a need for a geronto-psychiatric service. Two thirds (58,9 %) of them prefer a service available during office hours. GPs estimate that 63 % of their nursing home residents suffer from psychiatric symptoms (dementia in 60 %, depression in 23 %, sleep disorders in 11 %). Antipsychotics are prescribed most often (in 50,6 %). Discussion: GPs in the canton of Basel-Stadt see a need for an outpatient geronto-psychiatric service. Psychiatric symptoms are common among residents of nursing homes.
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Affiliation(s)
- Niclas Kiss
- Universitäres Zentrum für Hausarztmedizin beider Basel uniham-bb, Basel
| | | | - Andreas Zeller
- Universitäres Zentrum für Hausarztmedizin beider Basel uniham-bb, Basel
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Wauters M, Elseviers M, Vander Stichele R, Dilles T, Thienpont G, Christiaens T. Efficacy, feasibility and acceptability of the OptiMEDs tool for multidisciplinary medication review in nursing homes. Arch Gerontol Geriatr 2021; 95:104391. [PMID: 33819776 DOI: 10.1016/j.archger.2021.104391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/28/2022]
Abstract
AIM(S) Exploring efficacy, feasibility and acceptability of a complex multifaced intervention (OptiMEDs) supporting multidisciplinary medication reviews in Belgian nursing homes (NHs). METHODS A pilot study in 2 intervention, 1 control NH was held, involving dementia and non-dementia NH residents (>65 years). OptiMEDs provided automated assessment of possible inappropriate medications (PIMs) and patient-specific nurse observation lists of potential side-effects. Medication changes were evaluated one month after the medication review. Feasibility and acceptability was collected via surveys among the health-care professionals. Trial registration NCT04142645, 31/10/2019. RESULTS Participants (n = 148, n = 100 in the intervention NHs) had a mean age of 87.2 years, with 75.0% females and 49.3% non-dementia patients. Prevalence of PIM use was 84.7% and of potential medication side-effects 84.5%, (range 1-19 per resident). One month after the intervention, the medication use decreased in 35.8% and PIM use in 25.9% of surviving intervention NHresidents (n = 88). GPs changed more medications when side-effects were observed (42% when side-effects present versus 12% when no side-effects, p = 0.019). Median workload for nurses was 45 min, 20 for pharmacists, and 8 for GPs. User satisfaction for the OptiMEDs tool was high (n = 33, median score of 8, IQR 6 -8), with GPs (n = 19) showing the highest appreciation. Nurses (n = 9) reported a median score on the System Usability Scale of 70 (IQR 55 - 72), with lower scores for learnability aspects. CONCLUSION The OptiMEDs intervention was feasible and user-friendly, showing decreases in the medication and PIM use; without affecting patient safety. A cluster-randomized trial is needed to explore impact on patient-related outcomes.
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Affiliation(s)
- Maarten Wauters
- Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium.
| | - Monique Elseviers
- Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium; University of Antwerp, Centre for Research and Innovation in Care (CRIC), Wilrijk, Belgium
| | - Robert Vander Stichele
- Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium; RAMIT vzw, Research in Advanced Medical Informatics and Telematics, Ghent, Belgium
| | - Tinne Dilles
- University of Antwerp, Centre for Research and Innovation in Care (CRIC), Wilrijk, Belgium
| | - Geert Thienpont
- RAMIT vzw, Research in Advanced Medical Informatics and Telematics, Ghent, Belgium
| | - Thierry Christiaens
- Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
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CYP2D6-inhibiting drugs and risk of fall injuries after newly initiated antidepressant and antipsychotic therapy in a Swedish, register-based case-crossover study. Sci Rep 2021; 11:5796. [PMID: 33707555 PMCID: PMC7970948 DOI: 10.1038/s41598-021-85022-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
Drug-drug interactions have been shown to affect the risk of fall injuries when opioids are used concomitantly with drugs inhibiting the cytochrome P450 2D6 (CYP2D6) enzyme in a previous pharmacoepidemiological study. The aim of this study was to determine whether CYP2D6-inhibiting drugs reinforce the risk of fall injuries when used concomitantly with antidepressants or antipsychotics. We identified all 252,704 adults with a first fall injury leading to hospitalisation from the National Patient Register in Sweden 2006–2013. Data on dispensed drugs was linked from the Swedish Prescribed Drug Register. We applied a case-crossover design to analyse newly dispensed (28 days preceding the fall injury, preceded by a 12-week washout period) antidepressants and antipsychotics, respectively, in relation to risk of a fall injury and according to concomitant use of CYP2D6-inhibiting drugs. Newly dispensed drugs were assessed correspondingly in a control period of equal length, 28 days prior to the 12-week washout period. Overall, the risk of fall injury was increased after newly initiated antidepressant and antipsychotic treatment. For antidepressants, concomitant CYP2D6 inhibitor use further elevated the risk estimates compared to non-use, most pronounced for the groups selective serotonin reuptake inhibitors (sertraline excluded) [OR = 1.47 (95% CI 1.19–1.80) vs. OR = 1.19 (95% CI 1.13–1.26)], and tricyclic antidepressants [OR = 1.71 (95% CI 1.17–2.51) vs. 1.27 (95% CI 1.11–1.47)] as well as for sertraline [OR = 1.61 (95% CI 1.05–2.38) vs. 1.12 (95% CI 1.00–1.26)]. For antipsychotics, the risk of fall injury was not altered by concomitant use of CYP2D6-inhibiting drugs. In conclusion, concomitant use of CYP2D6 inhibiting drugs tends to further increase the risk of fall injury in newly initiated antidepressant treatment, but not in antipsychotic treatment.
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Nacamura PAB, Cardoso LCB, Rêgo ADS, Sanches RDCN, Radovanovic CAT, Paiano M. Uso de psicotrópicos por pessoas idosas com hipertensão: prevalência e fatores associados. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.200287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo analisar os fatores associados ao uso de psicotrópicos por pessoas idosas com hipertensão arterial (HA) acompanhadas pela atenção primária. Método estudo transversal, realizado em um município do noroeste do estado do Paraná, Brasil. A coleta de dados foi realizada com pessoas idosas, no primeiro semestre de 2016, por intermédio de um instrumento adaptado e validado para avaliação da satisfação com os serviços da Atenção Primária à Saúde. Utilizou-se o modelo de regressão logística, com o método stepwise e a magnitude das associações foi estimada pelo cálculo de Razão de Prevalência (RP). Resultados participaram do estudo 260 pessoas idosas com HA, das quais 25,4% faziam uso de psicotrópicos, sendo a maioria com idade entre 60 e 69 anos (48,8%) e do sexo feminino (67,3%). A análise multivariada evidenciou que o uso de psicotrópicos é mais prevalente em idosos que fazem uso de tabaco (RP: 4,09; IC95%: 1,81–9,18), com circunferência abdominal alterada (RP: 2,58; IC95%: 1,29–5,18), com obesidade (RP: 2,43; IC95%: 1,30–4,55) e aos que relataram ter efeitos colaterais dos medicamentos utilizados no tratamento da HA (RP: 2,98; IC95%: 1,23–7,21). No contexto organizacional e relacionais das equipes da estratégia saúde da família, em idosos com hipertensão e que fazem uso de psicotrópicos observou-se maior prevalência na insatisfação com o atendimento (RP: 6,71; IC95%: 1,37–32,71) e com a falta de apoio e de compreensão com os problemas relatados durante as consultas (RP: 2,17; IC95%: 1,11–4,25). Conclusões Por ser um problema de saúde pública e que atinge parcela significativa da população com maior risco de agravos à saúde, destaca-se a importância de pesquisas nessa área, as quais busquem alternativas para melhorar a qualidade de vida da pessoa idosa com comorbidades e que utilizam psicotrópicos por meio de um cuidado integral.
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Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review. J Am Med Dir Assoc 2020; 21:1852-1861.e8. [DOI: 10.1016/j.jamda.2020.05.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/19/2023]
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Sedative Load in Community-Dwelling Older Adults with Mild-Moderate Alzheimer's Disease: Longitudinal Relationships with Adverse Events, Delirium and Falls. Drugs Aging 2020; 37:829-837. [PMID: 32924095 DOI: 10.1007/s40266-020-00800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Older adults are frequently prescribed medications with sedative effects, which are associated with numerous adverse consequences. However, the prevalence and longitudinal associations of sedative medication use in community-dwelling older adults with mild-moderate Alzheimer's disease (AD) has not been explored to date. OBJECTIVES Our objective was to assess the prevalence of sedative medication use in community-dwelling older adults with mild-moderate AD and examine the longitudinal association between sedative medication use and adverse events (AEs). METHODS The association between baseline sedative load (SL) and AEs, unscheduled healthcare utilisation, delirium and falls was assessed in older adults with mild-moderate AD over 18 months using secondary analysis of NILVAD trial data (collected from 2014 to 2016). Baseline medication use was assessed, and the SL model was applied to each participant's medication individually. The SL model classifies medications into one of four categories: (1) primary sedatives, (2) medications with a sedating component or prominent side effect, (3) medications with sedation as a potential adverse reaction and (4) all other medications with no known sedative side effects. Medications in group 1 were assigned an SL score of 2, those in group 2 were assigned an SL score of 1, and those in categories 3 and 4 an SL score of 0. SL scores for each medication participants were taking were summed and the total SL calculated as an arithmetic sum of individual medications score. A total SL score ≥ 3 was classed as high. Statistical analysis was conducted using Poisson regression and mixed-effects linear regression, with adjustment for important clinical covariates. We also assessed the impact of SL on dementia progression and cognitive decline. RESULTS Over half (55.7% [284/510]) of those with mild-moderate AD (age 72.8 ± 8.3 years, 61.9% female) were prescribed a regular medication with sedation as a primary effect or prominent side effect, with 22.2% (113/510) having a high SL (≥ 3). The most common medications contributing to SL were antidepressants, antipsychotics, anxiolytics and hypnotics. Over 18 months, increasing baseline SL was associated with incident AEs (incidence rate ratio [IRR] 1.15; 95% confidence interval [CI] 1.11-1.19; p < 0.001), serious AEs (IRR 1.23; 95% CI 1.11-1.36; p < 0.001) and unscheduled general practitioner visits (IRR 1.23; 95% CI 1.13-1.34; p < 0.001). Further, increasing SL was associated with a greater likelihood of incident delirium (IRR 1.30; 95% CI 1.11-1.53; p < 0.001) and falls (IRR 1.20; 95% CI 1.03-1.42; p = 0.02). Associations persisted after robust covariate adjustment. SL was not associated with accelerated cognitive decline or AD progression. CONCLUSIONS In the current study, over half of older adults with mild-moderate AD were prescribed at least one drug with a sedative effect, and a significant minority had a high SL. Increasing baseline SL was associated with a greater likelihood of incident AEs, delirium and falls, highlighting the need for optimal prescribing in this potentially vulnerable cohort.
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Rivasi G, Kenny RA, Ungar A, Romero-Ortuno R. Effects of benzodiazepines on orthostatic blood pressure in older people. Eur J Intern Med 2020; 72:73-78. [PMID: 31706708 DOI: 10.1016/j.ejim.2019.10.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Older people taking benzodiazepines (BDZs) have higher risk of falling, which is mainly attributed to cognitive and psychomotor effects. BDZs may also have hypotensive effects. We investigated the association between BDZs and orthostatic blood pressure behaviour in older people. METHODS We retrospectively analysed data from an outpatient clinic where people aged 60 or older underwent a geriatric assessment. Non-invasive beat-to-beat orthostatic systolic blood pressure (SBP) was assessed at regular time intervals before and after an active stand test. We compared clinical characteristics between BDZs users and non-users and also investigated if BDZs use was an independent predictor of baseline SBP. Factors associated with SBP change were investigated using a repeated measures general linear model. RESULTS Of 538 participants (67.7% female, mean age 72.7), 33 (6.1%) reported regular BDZs use. BDZ users had lower baseline SBP (149 versus 161 mmHg, P < 0.05). Multiple linear regression confirmed BDZs use as independent predictor of baseline SBP in N = =538. At 10 s post-stand, the SBP difference between BDZs use groups became maximum (21 mmHg); at this point, SBP still seemed to be decreasing in BDZ-users, whereas in controls it seemed to be recovering. After adjustment (age, sex, hypertension, frailty, comorbidity, antihypertensives), BDZs were associated with greater SBP reduction between baseline and 10 s post-stand (P < 0.05). CONCLUSION Older people taking BDZs may have a higher risk of orthostatic hypotension, perhaps due to an exaggerated immediate BP drop. This adds to other BDZ-related falls risks. BDZs should be avoided in older people at risk of falling.
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Affiliation(s)
- Giulia Rivasi
- Syncope Unit and Referral Centre for Hypertension in the Elderly, Department of Geriatrics and Geriatric Intensive Care Unit, Careggi Hospital and University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Rose Anne Kenny
- Discipline of Medical Gerontology and Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland.
| | - Andrea Ungar
- Syncope Unit and Referral Centre for Hypertension in the Elderly, Department of Geriatrics and Geriatric Intensive Care Unit, Careggi Hospital and University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology and Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland.
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Reducing Psychotropic Drug Use in Nursing Homes in Belgium: An Implementation Study for the Roll-Out of a Practice Improvement Initiative. Drugs Aging 2019; 36:769-780. [PMID: 31209735 DOI: 10.1007/s40266-019-00686-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper. METHODS The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016-November 2017). RESULTS At baseline, participants' (n = 677) mean age was 85.6 years (range 54-109 years), with 72.6% female. Mean medication intake was 8.5 (range 1-22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522). CONCLUSIONS The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months.
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Hasan SS, Zaidi STR, Nirwan JS, Ghori MU, Javid F, Ahmadi K, Babar ZUD. Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:E1292. [PMID: 31450830 PMCID: PMC6780105 DOI: 10.3390/jcm8091292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Both old age and institutionalization in aged care homes come with a significant risk of developing several long-term mental and neurological disorders, but there has been no definitive meta-analysis of data from studies to determine the pooled estimate of central nervous system (CNS) medicines use in aged care homes. We conducted this systematic review to summarize the use of CNS drugs among aged care homes residents. METHODS MEDLINE, EMBASE, CINAHL, Scopus, and International Pharmaceutical Abstracts (IPA) databases were searched (between 1 January 2000 and 31 December 2018) to identify population-based studies that reported the use of CNS medicines in aged care homes. Pooled proportions (with 95% confidence interval), according to study location were calculated. RESULTS A total of 89 studies reported the use of CNS medicines use in aged care. The pooled estimate of CNS drugs use varied according to country (from 20.3% in Ireland to 49.0% in Belgium) and region (from 31.7% in North America to 42.5% in Scandinavia). The overall pooled estimate of psychotropic medicines use was highest in Europe (72.2%, 95% CI, 67.1-77.1%) and lowest in ANZ region (56.9%, 95% CI, 52.2-61.4%). The pooled estimate of benzodiazepines use varied widely from 18.9% in North America to 44.8% in Europe. The pooled estimate of antidepressants use from 47 studies was 38.3% (95% CI 35.1% to 41.6%) with highest proportion in North America (44.9%, 95% CI, 35.3-54.5%). CONCLUSION The overall use of CNS drugs varied among countries, with studies from Australia-New Zealand reported the lowest use of CNS drugs. The criteria for prescribing CNS drugs in clinical practice should be evidence-based. The criteria should be used not to prohibit the use of the listed medications but to support the clinical judgement as well as patient safety.
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Affiliation(s)
- Syed Shahzad Hasan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK.
| | | | - Jorabar Singh Nirwan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Muhammad Usman Ghori
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Farideh Javid
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Keivan Ahmadi
- Lincoln Medical School-Universities of Nottingham and Lincoln, College of Science, Lincoln LN6 7TS, UK
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
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O'Connor DW, D'Cunha C, Clifton T, Huppert D, Lowy H, Macfarlane S, Moss F, Plakiotis C, Singh D, Tsanglis M, Hoeve JT, White E. Quality indicators of psychotropic prescribing to people with dementia in aged psychiatry inpatient units. Aging Ment Health 2018; 22:1432-1437. [PMID: 28846023 DOI: 10.1080/13607863.2017.1366418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To develop indicators of safe psychotropic prescribing practices for people with dementia and to test them in a convenience sample of six aged mental health services in Victoria, Australia. METHOD The clinical records of 115 acute inpatients were checked by four trained auditors against indicators derived from three Australian health care quality and safety standards or guidelines. Indicators addressed psychotropic medication history taking; the prescribing of regular and 'as needed' psychotropics; the documentation of psychotropic adverse reactions, and discharge medication plans. RESULTS The most problematic areas concerned the gathering of information about patients' psychotropic prescribing histories at the point of entry to the ward and, later, the handing over on discharge of information concerning newly prescribed treatments and the reasons for ceasing medications, including adverse reactions. There were wide variations between services. CONCLUSION The indicators, while drawn from current Australian guidelines, were entirely consistent with current prescribing frameworks and provide useful measures of prescribing practice for use in benchmarking and other quality improvement activities.
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Affiliation(s)
- Daniel W O'Connor
- a Department of Health and Human Services , Office of the Chief Psychiatrist , Melbourne , Victoria , Australia.,b Department of Psychiatry , Monash University , Melbourne , Victoria , Australia
| | - Craig D'Cunha
- c Aged Persons Mental Health Service , Peninsula Health , Melbourne , Victoria , Australia
| | - Tanya Clifton
- d Aged Persons Mental Health Service , St Vincent's Health , Melbourne , Victoria , Australia
| | - David Huppert
- e Aged Persons Mental Health Service , NorthWest Area Mental Health Service , Melbourne , Victoria , Australia
| | - Helen Lowy
- a Department of Health and Human Services , Office of the Chief Psychiatrist , Melbourne , Victoria , Australia
| | - Stephen Macfarlane
- f Aged Persons Mental Health Service , Alfred Health , Melbourne , Victoria , Australia
| | - Francine Moss
- d Aged Persons Mental Health Service , St Vincent's Health , Melbourne , Victoria , Australia
| | - Christos Plakiotis
- g Aged Persons Mental Health Service , Monash Health , Melbourne , Victoria , Australia
| | - Dhiren Singh
- c Aged Persons Mental Health Service , Peninsula Health , Melbourne , Victoria , Australia
| | - Maria Tsanglis
- f Aged Persons Mental Health Service , Alfred Health , Melbourne , Victoria , Australia
| | - Jodie Ten Hoeve
- g Aged Persons Mental Health Service , Monash Health , Melbourne , Victoria , Australia
| | - Erica White
- h Aged Persons Mental Health Service , Barwon Health , Geelong , Victoria , Australia
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13
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Łaszewska A, Österle A, Wancata J, Simon J. Prevalence of mental diseases in Austria : Systematic review of the published evidence. Wien Klin Wochenschr 2018; 130:141-150. [PMID: 29368240 PMCID: PMC5816100 DOI: 10.1007/s00508-018-1316-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Addressing the growing burden of mental diseases is a public health priority. Nevertheless, many countries lack reliable estimates of the proportion of the population affected, which are crucial for health and social policy planning. This study aimed to collect existing evidence on the prevalence of mental diseases in Austria. METHODS A systematic review was conducted using MeSH, EMTREE and free-text terms in seven bibliographic databases. In addition, the references of included papers and relevant Austria-specific websites were searched. Articles published after 1996 pertaining to the Austrian adult population and presenting prevalence data for mental diseases were included in the analysis. RESULTS A total of 2612 records were identified in the database search, 19 of which were included in the analysis, 13 were community-based studies and 6 examined institutionalized populations. Sample sizes ranged from 200 to 15,474. The evidence was centered around depression (n = 6, 32%), eating disorders (n = 4, 21%) and alcohol dependence (n = 3, 16%). While most studies (n = 10, 53%) used questionnaires and scales to identify mental diseases, seven studies used structured clinical interviews, and two studies examined use of psychotropic drugs. Due to the diversity of methodologies, no statistical pooling of prevalence estimates was possible. CONCLUSION Information on the prevalence of mental diseases in Austria is limited and comparability between studies is restricted. A variety of diagnostic instruments, targeted populations and investigated diseases contribute to discrepancies in the prevalence rates. A systematic, large-scale study on the prevalence of mental diseases in Austria is needed for comprehensive and robust epidemiological evidence.
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Affiliation(s)
- Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
| | - August Österle
- Institute for Social Policy, Vienna University of Economics and Business, Welthandelsplatz 1, 1020 Vienna, Austria
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
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Janus SIM, van Manen JG, Zuidema SU, Snijder C, Drossaert CHC, Ijzerman MJ. Reasons for (not) discontinuing antipsychotics in dementia. Psychogeriatrics 2018; 18:13-20. [PMID: 28745420 DOI: 10.1111/psyg.12280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/07/2017] [Accepted: 04/30/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The gap between high antipsychotic prescription rates for patients with dementia and the guidelines' advice to prescribe cautiously indicates that barriers to discontinuation exist. This exploratory study used the theory of planned behaviour to give a first overview of the factors that influence physicians to discontinue antipsychotics in nursing home patients with dementia. METHODS Forty-one physicians in the Netherlands completed an online survey based on the theory of planned behaviour. RESULTS Half of the respondents agreed that antipsychotics have positive consequences for patients, such as calming effects. Physicians who indicated that they tend not to discontinue antipsychotics believe that antipsychotics are associated with positive consequences for nursing home staff. Physicians who tend to discontinue antipsychotics had a higher perceived behavioural control than those who indicated having a low intention. CONCLUSION To enhance discontinuation of antipsychotics, interventions should focus on both patient-related factors and staff-related factors. Prescribing decisions are influenced by staff-related factors that need to be addressed as well.
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Affiliation(s)
- Sarah I M Janus
- Department Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Jeannette G van Manen
- Department Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carina Snijder
- Department Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Constance H C Drossaert
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Maarten J Ijzerman
- Department Health Technology and Services Research, University of Twente, Enschede, The Netherlands
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Azermai M, Wauters M, De Meester D, Renson L, Pauwels D, Peeters L, Warie H, Petrovic M. A quality improvement initiative on the use of psychotropic drugs in nursing homes in Flanders. Acta Clin Belg 2017; 72:163-171. [PMID: 28206874 DOI: 10.1080/17843286.2017.1287230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Government-funded quality improvement projects aimed to reduce the high psychotropic medication use in Belgian long-term care settings. DESIGN A pilot project (2013-2014) with a pre-post and follow-up intervention design. METHODS Two nursing homes received three educational courses. In the intervention nursing home (INH) additionally, a transition towards person-centred care through professional support was applied. Drug use was recorded at baseline, after 10 months (post) and after 22 months (follow-up), and coded into the Anatomical Therapeutic Chemical classification. RESULTS At baseline, the INH residents' (n = 118) mean age at baseline was 82 years, with 71% females. The control nursing home residents' (CNH, n = 275) mean age was 82.7 years, with 75% females. At baseline, mean drug use was 9 (range 1-21) and 8 (range 0-20), predominantly with a high proportion of psychotropic drug users of 73 and 65%, in INH and CNH respectively. At the time of post-measurement, only the proportion of hypno-sedative users decreased significantly in the INH (by 13%, p = 0.048). No significant changes were found in the CNH. At time of the follow-up, the proportion of hypno-sedative (51% vs. 31%; p = 0.005) and antidepressant users (42% vs. 25%, p = 0.007) decreased significantly in the INH. The decrease of antipsychotic drug users was less distinct. In the CNH, the proportion of hypno-sedative, antidepressant and overall psychotropic drug users did not change significantly. CONCLUSION This quality improvement initiative led to a significant decrease in the use of psychotropic drugs in the INH, even after 1-year follow-up. Education only had a limited effect.
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Affiliation(s)
- Majda Azermai
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
| | - Maarten Wauters
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
| | | | | | | | | | | | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium
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16
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Zeenny R, Wakim S, Kuyumjian YM. Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria. Clin Interv Aging 2017; 12:65-73. [PMID: 28115835 PMCID: PMC5221543 DOI: 10.2147/cia.s87564] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Potentially inappropriate medications (PIMs) should be avoided by the aged population. The aim of this study was to assess the prevalence of PIMs among Lebanese aged outpatients using Beers criteria of 2012. The secondary objectives were to identify the correlates of the PIMs use and to compare the PIMs prevalence rates as per Beers criteria of 2003 and 2012. Methods This cross-sectional observational study was conducted among aged outpatients of different accredited community pharmacies across Lebanon. Data were collected through a validated questionnaire. The Beers criteria of 2012 were used to evaluate PIMs. The association between PIMs used and independent variables were analyzed by logistic regression. The differences between PIMs use according to Beers criteria 2003 and 2012 were calculated using chi-squared and McNemar’s tests. Results A total of 248 outpatients were analyzed. We identified 112 (45.2%) out of 248 patients taking PIMs. The leading classes of medications identified to cause PIMs were those acting on the central nervous system (71.4%). The factors associated with PIMs use were age, osteoporosis, Alzheimer/dementia, diabetes, and alcohol consumption. PIMs use increased significantly between Beers criteria 2003 and 2012 (Chi-squared test, P<0.001; McNemar’s test, P<0.001). Conclusion Our study showed a high prevalence of PIMs use in Lebanon, which is associated with various correlates. Education of health care providers and medication review should be considered to improve medication safety of older adults.
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Affiliation(s)
- Rony Zeenny
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Samira Wakim
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Yara-Mary Kuyumjian
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
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Cox CA, van Jaarsveld HJ, Houterman S, van der Stegen JCGH, Wasylewicz ATM, Grouls RJE, van der Linden CMJ. Psychotropic Drug Prescription and the Risk of Falls in Nursing Home Residents. J Am Med Dir Assoc 2016; 17:1089-1093. [PMID: 27650670 DOI: 10.1016/j.jamda.2016.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/01/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Falling is a common and serious problem in the elderly. Previous studies suggest that the use of psychotropic drugs increases the risk of falling. However, the contribution of these drugs on fall risk has not been quantified on a daily basis among the general population of nursing homes until now. OBJECTIVE To assess the association between fall incidence and the prescription of psychotropic drugs and different categories of psychotropic drugs (antipsychotics, antidepressants, and benzodiazepines) among a general nursing home population. DESIGN Retrospective observational study, data collection per person-day. SETTING 9 nursing homes in Eindhoven, the Netherlands. PARTICIPANTS 2368 nursing home residents, resulting in 538,575 person-days. MAIN OUTCOME MEASURE Association between the prescription of psychotropic drugs and falls. RESULTS A total of 2368 nursing home residents were included, which resulted in a data set of 538,575 person-days. Prescription of at least 1 psychotropic drug per day occurred during a total of 318,128 person-days (59.1%). Scheduled prescriptions with or without an as-needed prescription were involved in a total of 270,781 person-days (50.3%). The prescription of psychotropic drugs on a scheduled basis was found to be associated with almost a 3-fold increase in fall incidence (OR 2.88; 95% CI 1.52-5.44). An increase in fall incidence was found following the prescription of antipsychotics (OR 1.97; 95% CI 1.51-2.59) and antidepressants (OR 2.26; 95% CI 1.73-2.95). This increased fall risk was found for prescriptions on a scheduled basis as well as for prescriptions on an as-needed basis. CONCLUSION The prescription of psychotropic drugs is associated with a strongly increased risk of falling among nursing home residents. To our knowledge, this is the first study among the general nursing home population in which the association between daily falls and daily prescriptions of psychotropic drugs and groups of psychotropic drugs was specified.
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Affiliation(s)
- Claudia A Cox
- Department of Geriatrics, Catharina Hospital, Eindhoven, the Netherlands; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Rene J E Grouls
- Department of Clinical Pharmacy, Catharina Hospital, Eindhoven, the Netherlands
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Abstract
The aim of this study was to investigate the characteristics and treatment patterns of older antipsychotic (AP) users in Germany. We carried out a cohort study in the German Pharmacoepidemiological Research Database and identified new AP users aged at least 65 years between 2005 and 2011. Possible indications, comedication, and information on persistence and adherence, concurrent multiple use, and switch of APs were assessed. Overall, 298,847 individuals were included in the cohort. Almost 70% entered the cohort with a typical antipsychotic (TAP). Melperone (23.4%) was used most frequently, followed by promethazine (18.3%), sulpiride (11.0%), and risperidone (10.3%). AP users had a low prevalence of schizophrenia and bipolar disorders in contrast to dementia. Initiators of atypical antipsychotics had more treatment episodes compared with TAPs (median 3 vs. 2), but lower median persistence (14 vs. 22 days). Persistence was also lower in patients with, rather than without, dementia. The overall percentage of concurrent multiple use and switch to other APs was low with 5.6%, but higher in patients with, rather than without, dementia. In conclusion, APs were used for a broad range of indications, mostly other than schizophrenia and bipolar disorders. Low persistence and a high number of treatment episodes suggest frequent 'as-needed' treatment, especially in dementia patients.
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19
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Stroka MA. Drug overprescription in nursing homes: an empirical evaluation of administrative data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:257-267. [PMID: 25749894 DOI: 10.1007/s10198-015-0676-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 02/23/2015] [Indexed: 06/04/2023]
Abstract
A widely discussed shortcoming of long-term care in nursing homes for the elderly is the inappropriate or suboptimal drug utilization, particularly of psychotropic drugs. Using administrative data from the largest sickness fund in Germany, this study was designed to estimate the effect of institutionalization on the drug intake of the frail elderly. Difference-in-differences propensity score matching techniques were used to compare drug prescriptions for the frail elderly who entered a nursing home with those who remained in the outpatient care system; findings suggest that nursing home residents receive more doses of antipsychotics, antidepressants, and analgesics. The potential overprescription correlates with estimated drug costs of about €87 million per year.
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Affiliation(s)
- Magdalena A Stroka
- RWI Essen, Essen, Germany.
- Department of Economics, Ruhr-Universität Bochum, Universitätsstr. 150, 44801, Bochum, Germany.
- WINEG-Scientific Institute of TK for Benefit and Efficiency in Health Care, Hamburg, Germany.
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20
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Shaw C, McCormack B, Hughes CM. Prescribing of Psychoactive Drugs for Older People in Nursing Homes: An Analysis of Treatment Culture. Drugs Real World Outcomes 2016; 3:121-130. [PMID: 27747811 PMCID: PMC4819472 DOI: 10.1007/s40801-016-0066-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is increasing interest in how culture may affect the quality of healthcare services, and previous research has shown that 'treatment culture'-of which there are three categories (resident centred, ambiguous and traditional)-in a nursing home may influence prescribing of psychoactive medications. OBJECTIVE The objective of this study was to explore and understand treatment culture in prescribing of psychoactive medications for older people with dementia in nursing homes. METHOD Six nursing homes-two from each treatment culture category-participated in this study. Qualitative data were collected through semi-structured interviews with nursing home staff and general practitioners (GPs), which sought to determine participants' views on prescribing and administration of psychoactive medication, and their understanding of treatment culture and its potential influence on prescribing of psychoactive drugs. Following verbatim transcription, the data were analysed and themes were identified, facilitated by NVivo® and discussion within the research team. RESULTS Interviews took place with five managers, seven nurses, 13 care assistants and two GPs. Four themes emerged: the characteristics of the setting, the characteristics of the individual, relationships and decision making. The characteristics of the setting were exemplified by views of the setting, daily routines and staff training. The characteristics of the individual were demonstrated by views on the personhood of residents and staff attitudes. Relationships varied between staff within and outside the home. These relationships appeared to influence decision making about prescribing of medications. The data analysis found that each home exhibited traits that were indicative of its respective assigned treatment culture. CONCLUSION Nursing home treatment culture appeared to be influenced by four main themes. Modification of these factors may lead to a shift in culture towards a more flexible, resident-centred culture and a reduction in prescribing and use of psychoactive medication.
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Affiliation(s)
- Catherine Shaw
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK
| | - Brendan McCormack
- School of Health Sciences, Queen Margaret University, Musselburgh, Scotland, UK
| | - Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.
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Alzner R, Bauer U, Pitzer S, Schreier MM, Osterbrink J, Iglseder B. Polypharmacy, potentially inappropriate medication and cognitive status in Austrian nursing home residents: results from the OSiA study. Wien Med Wochenschr 2016; 166:161-5. [PMID: 26847440 DOI: 10.1007/s10354-015-0428-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Abstract
There is little research investigating polypharmacy and potentially inappropriate medications (PIM) in connection with cognitive status in residents of Austrian nursing homes. Our findings result from a cross-sectional survey of 425 residents (315 women, 110 men, mean 83.6 years) from 12 Austrian nursing homes. The number of systemically administered permanent prescription drugs was 8.99 ± 3.9 and decreased significantly with increasing cognitive impairment. Irrespective of cognitive status, polypharmacy (> 5 individual substances) was present in approximately 75% of the residents. Hyper-polypharmacy (> 10 individual substances) was present among almost 50% of the cognitively intact residents, and hence, significantly more frequent as compared with the group with the lowest cognitive performance (23.4%). At least one PIM was found in 72.4% of residents regardless of cognitive status. Predominantly, PIMs consisted of tranquilizers, antipsychotics, osmotic laxatives, non-steroidal anti-inflammatory drugs (NSAIDs) and anticholinergics, where only the number of NSAIDs decreased significantly with increasing cognitive impairment. In summary, our study shows a continued high prevalence of polypharmacy and PIM in long-term care institutions in Austria.
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Affiliation(s)
- Reinhard Alzner
- Department of Geriatric Medicine, Salzburger Landeskliniken Betriebs-GesmbH, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz Harrer-Straße 79, 5020, Salzburg, Austria.
| | - Ulrike Bauer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Stefan Pitzer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Maria Magdalena Schreier
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Salzburger Landeskliniken Betriebs-GesmbH, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz Harrer-Straße 79, 5020, Salzburg, Austria
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Foebel A, Ballokova A, Wellens NIH, Fialova D, Milisen K, Liperoti R, Hirdes JP. A retrospective, longitudinal study of factors associated with new antipsychotic medication use among recently admitted long-term care residents. BMC Geriatr 2015; 15:128. [PMID: 26482028 PMCID: PMC4615888 DOI: 10.1186/s12877-015-0127-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 10/12/2015] [Indexed: 12/01/2022] Open
Abstract
Background Use of antipsychotic (AP) medications is high and often inappropriate among institutionalized populations. Little is known about the correlates of new AP drug use following admission to long-term care (LTC) settings. This study investigated the frequency and correlates of new AP drug use among newly admitted LTC residents. Methods This longitudinal, retrospective study used data from the interRAI - Nursing Home Minimum Data Set version 2.0 (MDS 2.0) instrument. Data about demographic, clinical and social characteristics, and medication use, were collected in Ontario, Canada, from 2003–2011 by trained nurses. Residents with complete admission and 3–6 month follow-up data were included (N = 47,768). Multivariate logistic regression analyses, stratified by gender, explored correlates of new AP drug use upon admission to LTC. Results New AP drug users comprised 7 % of the final cohort. Severe cognitive impairment, dementia, and motor agitation were significantly associated with new AP drug use among both sexes. Additionally, behavioural problems, conflicts with staff and reduced social engagement were strong correlates of new AP drug use. Conclusions Social factors were as strongly associated with new AP drug use after LTC admission as clinical factors. Strategies to prevent the potential misuse of AP drugs upon LTC admission should consider the social determinants of such prescribing.
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Affiliation(s)
- Andrea Foebel
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden. .,School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
| | - Anna Ballokova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Nathalie I H Wellens
- Department of Public Health and Primary Care, Center for Health Services and Nursing Research, KULeuven, Leuven, Belgium. .,Geriatrics Center and Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA.
| | - Daniela Fialova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic. .,Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Prague, Czech Republic.
| | - Koen Milisen
- Department of Public Health and Primary Care, Center for Health Services and Nursing Research, KULeuven, Leuven, Belgium. .,Division of Geriatric Medicine, Leuven University Hospital, Herestraat 49, Leuven, 3000, Belgium.
| | - Rosa Liperoti
- Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
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Jacquin-Piques A, Sacco G, Tavassoli N, Rouaud O, Bejot Y, Giroud M, Robert P, Vellas B, Bonin-Guillaume S. Psychotropic Drug Prescription in Patients with Dementia: Nursing Home Residents Versus Patients Living at Home. J Alzheimers Dis 2015; 49:671-80. [DOI: 10.3233/jad-150280] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Agnès Jacquin-Piques
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Guillaume Sacco
- Centre Mémoire de Ressource et de Recherche, EA CoBTeK, Université de Nice Sophia-Antipolis, Nice, France
| | - Neda Tavassoli
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Olivier Rouaud
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Yannick Bejot
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Maurice Giroud
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Philippe Robert
- Centre Mémoire de Ressource et de Recherche, EA CoBTeK, Université de Nice Sophia-Antipolis, Nice, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sylvie Bonin-Guillaume
- University Hospital AP-HM, Department of Internal Medicine and Geriatrics, Aix Marseille University, Marseille, France
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25
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Azermai M. Dealing with behavioral and psychological symptoms of dementia: a general overview. Psychol Res Behav Manag 2015; 8:181-5. [PMID: 26170729 PMCID: PMC4498729 DOI: 10.2147/prbm.s44775] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Dealing with the behavioral and psychological symptoms of dementia (BPSD) is often complex. Given the controversy with regard to antipsychotics for behavioral problems in people with dementia, there has been a renewed emphasis on nonpharmacological interventions, with progress in the design of the relevant studies. Potential nonpharmacological interventions for BPSD are: cognitive training/stimulation, rehabilitative care, activities of daily living, music therapy, massage/touch, physical activity, education/training of professionals, and education and psychosocial support of informal caregivers. Use of antipsychotics in the management of BPSD is controversial due to limited efficacy and the risk of serious adverse effects, but credible alternatives remain scarce. The problem of chronic use of antipsychotics in nursing homes should be tackled. Discontinuation of antipsychotic medication in older individuals with BPSD appears to be feasible. Discontinuation efforts are needed to differentiate between patients for whom antipsychotics have no added value and patients for whom the benefits outweigh the risks.
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Affiliation(s)
- Majda Azermai
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
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Laffon de Mazières C, Lapeyre-Mestre M, Vellas B, de Souto Barreto P, Rolland Y. Organizational Factors Associated With Inappropriate Neuroleptic Drug Prescribing in Nursing Homes: A Multilevel Approach. J Am Med Dir Assoc 2015; 16:590-7. [DOI: 10.1016/j.jamda.2015.01.092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 01/08/2023]
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Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications in People With Dementia Resident in Care Homes: A Systematic Review. J Am Med Dir Assoc 2014; 15:706-18. [DOI: 10.1016/j.jamda.2014.06.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/13/2014] [Indexed: 11/22/2022]
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Bretschneider W. Die neue Schweizer Gesetzgebung zu bewegungseinschränkenden Maßnahmen auf dem medizinethischen Prüfstand. Ethik Med 2014. [DOI: 10.1007/s00481-014-0317-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND The prescription of antidepressants in nursing homes has increased markedly since the introduction of SSRIs, while at the same time depressive symptoms often go unrecognized and untreated. The aim of this study was to examine whether depression among residents in nursing homes is treated adequately. METHODS A sample of 429 participants from 11 Swedish nursing homes was selected and was assessed with the Cornell Scale for Depression in Dementia (CSDD) and using medical records and drug prescription data. For 256 participants a follow-up assessment was performed after 12 months. RESULTS The prevalence of depression, according to medical records, was 9.1%, and the prevalence of CSDD score of ≥8 was 7.5%. Depression persisted in more than 50% of cases at the 12-month follow-up. Antidepressants were prescribed to 33% of the participants without a depression diagnosis or with a CSDD score of <8. 46.2% of all participants were prescribed antidepressants. 14% of the participants without a depression diagnosis or with a CSDD score of <8 had psychotropic polypharmacy. 15.2% of all participants had psychotropic polypharmacy, which persisted at the 12-month follow-up in three-quarters of cases. CONCLUSION The prescription of antidepressants in frail elderly individuals is extensive and may be without clear indication. The clinical implication is that there is a need for systematic drug reviews at nursing homes, paying special attention to the subjects which are on antidepressants.
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Torsadogenic risk of antipsychotics: combining adverse event reports with drug utilization data across Europe. PLoS One 2013; 8:e81208. [PMID: 24278396 PMCID: PMC3835678 DOI: 10.1371/journal.pone.0081208] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 10/09/2013] [Indexed: 01/05/2023] Open
Abstract
Background Antipsychotics (APs) have been associated with risk of torsade de Pointes (TdP). This has important public health implications. Therefore, (a) we exploited the public FDA Adverse Event Reporting System (FAERS) to characterize their torsadogenic profile; (b) we collected drug utilization data from 12 European Countries to assess the population exposure over the 2005-2010 period. Methods FAERS data (2004-2010) were analyzed based on the following criteria: (1) ≥4 cases of TdP/QT abnormalities; (2) Significant Reporting Odds Ratio, ROR [Lower Limit of the 95% confidence interval>1], for TdP/QT abnormalities, adjusted and stratified (Arizona CERT drugs as effect modifiers); (3) ≥4 cases of ventricular arrhythmia/sudden cardiac death (VA/SCD); (4) Significant ROR for VA/SCD; (5) Significant ROR, combined by aggregating TdP/QT abnormalities with VA and SCD. Torsadogenic signals were characterized in terms of signal strength: from Group A (very strong torsadogenic signal: all criteria fulfilled) to group E (unclear/uncertain signal: only 2/5 criteria). Consumption data were retrieved from 12 European Countries and expressed as defined daily doses per 1,000 inhabitants per day (DID). Results Thirty-five antipsychotics met at least one criterium: 9 agents were classified in Group A (amisulpride, chlorpromazine, clozapine, cyamemazine, haloperidol, olanzapine, quetiapine, risperidone, ziprasidone). In 2010, the overall exposure to antipsychotics varied from 5.94 DID (Estonia) to 13.99 (France, 2009). Considerable increment of Group A agents was found in several Countries (+3.47 in France): the exposure to olanzapine increased across all Countries (+1.84 in France) and peaked 2.96 in Norway; cyamemazine was typically used only in France (2.81 in 2009). Among Group B drugs, levomepromazine peaked 3.78 (Serbia); fluphenazine 1.61 (Slovenia). Conclusions This parallel approach through spontaneous reporting and drug utilization analyses highlighted drug- and Country-specific scenarios requiring potential regulatory consideration: levomepromazine (Serbia), fluphenazine (Slovenia), olanzapine (across Europe), cyamemazine (France). This synergy should be encouraged to support future pharmacovigilance activities.
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Ruths S, Sørensen PH, Kirkevold Ø, Husebø BS, Krüger K, Halvorsen KH, Selbaek G. Trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009: a comparison of six cohorts. Int J Geriatr Psychiatry 2013; 28:868-76. [PMID: 23147389 DOI: 10.1002/gps.3902] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 10/16/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Psychotropic drugs are extensively prescribed for the treatment of neuropsychiatric symptoms, despite modest efficacy and severe side effects. AIMS We examined trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009, in order to gain insight in practice development. METHODS The study is a secondary data analysis of six cross-sectional nursing home studies conducted between 1997 and 2009. Patients aged >65 years were included. We compared the prevalence of psychotropic drugs (antipsychotics, anxiolytics, hypnotics, and antidepressants). Associations between prescription of psychotropics, and patients' age, gender, type of ward, and year of data collection were examined by univariate analysis and logistic regression. RESULTS Altogether, 7 661 patients (mean age 85.2 years, 72.6% women) were included. Prevalence of all psychotropic drugs combined increased from 57.6% to 70.5%, anxiolytics from 14.9% to 21.9%, hypnotics from 14.5% to 22.9%, and antidepressants from 31.5% to 50.9%. Prevalence of antipsychotics varied between extremes 21.1% and 25.6%. Less prescribing of older drugs was exceeded by an increase in newer drug types. Concomitant prescribing of two or more psychotropic drugs increased from 21% to 33%. Predictors of psychotropic drugs were female gender (except antipsychotics), as well as age <80 years, and residency in special care units (except hypnotics). CONCLUSIONS Prescribing of psychotropic drugs in nursing homes has increased considerably, especially regarding antidepressants. Explanations for this trend need to be further explored.
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Affiliation(s)
- Sabine Ruths
- Research Unit for General Practice, Uni Health/Uni Research, Bergen, Norway
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Azermai M, Bourgeois J, Somers A, Petrovic M. Inappropriate use of psychotropic drugs in older individuals: implications for practice. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/ahe.13.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Frailty at old age and institutionalization in nursing homes are often associated with multiple chronic diseases (multimorbidity) requiring multiple medications (polypharmacy). Among these chronic conditions, mental health problems (e.g., dementia, depression and insomnia) are common. Psychotropic drugs are frequently used as a treatment approach for these conditions, and the prevalence of their use is high among community-dwelling older adults, but even higher in nursing homes. Furthermore, within the problem of polypharmacy and inappropriate prescribing, psychotropic drugs (defined in this article as antipsychotics, benzodiazepines and antidepressants) constitute a significant proportion. The use of psychotropics in older adults remains controversial given the risk of adverse effects, in contrast to the limited effectiveness. Guidelines advise a thorough risk–benefit analysis before the initiation of psychotropics, in addition to time-limited use and discontinuation. In the future, serious efforts should be undertaken to tackle the burden of inappropriate psychotropic prescribing in older adults by incorporating a multidisciplinary approach and by offering credible alternatives.
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Affiliation(s)
- Majda Azermai
- Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium.
| | - Jolyce Bourgeois
- Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium
| | - Annemie Somers
- Department of Pharmacy, Ghent University Hospital, Gent, Belgium
| | - Mirko Petrovic
- Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium
- Department of Geriatrics, Ghent University Hospital, Gent, Belgium
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Vieira de Lima TJ, Garbin CAS, Garbin AJÍ, Sumida DH, Saliba O. Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes. BMC Geriatr 2013; 13:52. [PMID: 23718678 PMCID: PMC3679980 DOI: 10.1186/1471-2318-13-52] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings. METHODS We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression. RESULTS Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404). CONCLUSIONS The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.
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Affiliation(s)
- Thaís Jaqueline Vieira de Lima
- Department of Child and Social Dentistry, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), 1193 José Bonifácio Street, Araçatuba, SP 16015-050, Brazil
| | - Cléa Adas Saliba Garbin
- Department of Child and Social Dentistry, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), 1193 José Bonifácio Street, Araçatuba, SP 16015-050, Brazil
| | - Artênio José Ísper Garbin
- Department of Child and Social Dentistry, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), 1193 José Bonifácio Street, Araçatuba, SP 16015-050, Brazil
| | - Dóris Hissako Sumida
- Department of Basic Sciences, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), Araçatuba, SP, Brazil
| | - Orlando Saliba
- Department of Child and Social Dentistry, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), 1193 José Bonifácio Street, Araçatuba, SP 16015-050, Brazil
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van de Ven-Vakhteeva J, Bor H, Wetzels RB, Koopmans RTCM, Zuidema SU. The impact of antipsychotics and neuropsychiatric symptoms on the quality of life of people with dementia living in nursing homes. Int J Geriatr Psychiatry 2013; 28:530-8. [PMID: 22886912 DOI: 10.1002/gps.3858] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/25/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to establish whether antipsychotic (AP) use in patients with dementia negatively affects quality of life (QoL) independent of neuropsychiatric symptoms (NPS). METHOD We tested 290 patients with dementia living in nine nursing homes throughout the Netherlands in a longitudinal study. The measurements were repeated every 6 months over 2 years. We studied the change in NPS and AP use and their effect on QoL over time in two separate generalized estimating equations. We assessed QoL and NPS using the Qualidem questionnaire and the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), respectively. RESULTS Antipsychotic prescriptions did not significantly change participant QoL, whereas NPI-NH total score changes consistently predicted changes in QoL. According to the Qualidem, the development of QoL in patients who chronically used APs did not differ from AP-free patients, except on the restless tense behavior subscale. AP-free patients' "restless tense behavior" improved compared with patients who chronically used APs, who showed a slight deterioration in these symptoms; however, this effect did not significantly influence total QoL. CONCLUSION Antipsychotic use does not necessarily have detrimental effects on the QoL of patients with dementia; rather, NPS consistently and negatively affects QoL. The use of APs to treat NPS is justified when used carefully (i.e., their benefits and side effects should be monitored).
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Affiliation(s)
- Julia van de Ven-Vakhteeva
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Alzheimer Center Nijmegen, Radboud University Nijmegen, Medical Center, Nijmegen, The Netherlands.
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Mann E, Haastert B, Böhmdorfer B, Frühwald T, Iglseder B, Roller-Wirnsberger R, Meyer G. Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study. Wien Klin Wochenschr 2013; 125:180-8. [PMID: 23536016 DOI: 10.1007/s00508-013-0342-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 02/25/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents' characteristics. OBJECTIVE The aim of our study was to analyse the prevalence and associations of PIP with residents' and facilities' characteristics. METHODS We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents' characteristics associated with PIP. RESULTS Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 % (95 % CI 67.2-73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 %). The most often prescribed PIP were Prothipendyl (25.9 % residents), Lorazepam (14.5 %) and Diclofenac (6.1 %). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents. CONCLUSIONS Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.
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Affiliation(s)
- Eva Mann
- Institute of General Medicine, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
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Sterke CS, van Beeck EF, van der Velde N, Ziere G, Petrovic M, Looman CWN, van der Cammen TJM. New Insights: Dose-Response Relationship Between Psychotropic Drugs and Falls: A Study in Nursing Home Residents With Dementia. J Clin Pharmacol 2013; 52:947-55. [DOI: 10.1177/0091270011405665] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maguire A, Hughes C, Cardwell C, O'Reilly D. Psychotropic medications and the transition into care: a national data linkage study. J Am Geriatr Soc 2013; 61:215-21. [PMID: 23320828 DOI: 10.1111/jgs.12101] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine whether excessive and often inappropriate or dangerous psychotropic drug dispensing to older adults is unique to care homes or is a continuation of community treatment. DESIGN Population-based data-linkage study using prescription drug information. SETTING Northern Ireland's national prescribing database and care home information from the national inspectorate. PARTICIPANTS Two hundred fifty thousand six hundred seventeen individuals aged 65 and older. MEASUREMENTS Prescription information was extracted for all psychotropic drugs included in the British National Formulary (BNF) categories 4.1.1, 4.1.2, and 4.2.2 (hypnotics, anxiolytics, and antipsychotics) dispensed over the study period. Repeated cross-sectional analysis was used to monitor changes in psychotropic drug dispensing over time. RESULTS Psychotropic drug use was higher in care homes than the community; 20.3% of those in care homes were dispensed an antipsychotic in January 2009, compared with 1.1% of those in the community. People who entered care had higher use of psychotropic medications before entry than those who did not enter care, but this increased sharply in the month of admission and continued to rise. Antipsychotic drug dispensing increased from 8.2% before entry to 18.6% after entering care (risk ratio (RR) = 2.26, 95% confidence interval (CI)=1.96-2.59) and hypnotic drug dispensing from 14.8% to 26.3% (RR=1.78, 95% CI=1.61-1.96). CONCLUSION A continuation of high use before entry cannot wholly explain the higher dispensing of psychotropic drugs to individuals in care homes. Although drug dispensing is high in older people in the community, it increases dramatically on entry to care. Routine medicine reviews are necessary in older people and are especially important during transitions of care.
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Affiliation(s)
- Aideen Maguire
- Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Belfast, Ireland.
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Cestac P, Tavassoli N, Vellas B, Rolland Y. Improving Medication Use in the Nursing Homes: A European Perspective. J Am Med Dir Assoc 2013; 14:6-9. [DOI: 10.1016/j.jamda.2012.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 11/26/2022]
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Richter T, Meyer G, Möhler R, Köpke S. Psychosocial interventions for reducing antipsychotic medication in care home residents. Cochrane Database Syst Rev 2012; 12:CD008634. [PMID: 23235663 PMCID: PMC6492452 DOI: 10.1002/14651858.cd008634.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Antipsychotic medication is regularly prescribed in care homes to control 'behavioural and psychological symptoms of dementia' despite moderate efficacy, significant adverse effects, and available non-pharmacological alternatives. OBJECTIVES To evaluate the effectiveness of psychosocial interventions to reduce antipsychotic medication in care home residents. SEARCH METHODS The Cochrane Dementia and Cognitive Improvement Group's Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, a number of trial registers and grey literature sources were searched on 19th December 2011. SELECTION CRITERIA Individual or cluster-randomised controlled trials comparing a psychosocial intervention aimed at reducing antipsychotic medication with usual care in care home residents or comparing two different approaches. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the retrieved articles for relevance and methodological quality and extracted data. Critical appraisal of studies addressed risk of bias through selection bias, performance bias, attrition bias, and detection bias, as well as criteria related to cluster design. Authors of relevant studies were contacted for additional information.Owing to clinical heterogeneity of interventions, statistical heterogeneity was not assessed and no meta-analysis performed. Study results are presented in a narrative form. MAIN RESULTS Four cluster-randomised controlled studies met the inclusion criteria. All of them investigated complex interventions comprising educational approaches. Three studies offered education and training for nursing staff, one study offered multidisciplinary team meetings as main component of the intervention. There was one high-quality study, but overall the methodological quality of studies was moderate. The studies revealed consistent results for the primary end point. All studies documented a decrease of the proportion of residents with antipsychotic drug use or a reduction in days with antipsychotic use per 100 days per resident, respectively. In summary, the reviewed evidence on psychosocial interventions targeting professionals is consistent with a reduction of antipsychotic medication prescription in care home residents. However, owing to heterogeneous approaches, summary effect sizes cannot be determined. AUTHORS' CONCLUSIONS There is evidence to support the effectiveness of psychosocial interventions for reducing antipsychotic medication in care home residents. However, the review was based on a small number of heterogeneous studies with important methodological shortcomings. The most recent and methodologically most rigorous study showed the most pronounced effect.
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Affiliation(s)
- Tanja Richter
- University of HamburgUnit of Health Sciences and EducationMartin‐Luther‐King‐Platz 6HamburgGermanyD‐20146
| | - Gabriele Meyer
- Witten/Herdecke UniversitySchool of Nursing Science, Faculty of HealthStockumer Str. 12WittenGermanyD‐58453
| | - Ralph Möhler
- Witten/Herdecke UniversitySchool of Nursing Science, Faculty of HealthStockumer Str. 12WittenGermanyD‐58453
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Avila-Castells P, Garre-Olmo J, Calvó-Perxas L, Turró-Garriga O, Alsina E, Carmona O, Perkal H, Roig AM, Cuy JM, Lozano M, Molins A, Vallmajó N, López-Pousa S. Drug use in patients with dementia: a register-based study in the health region of Girona (Catalonia/Spain). Eur J Clin Pharmacol 2012. [PMID: 23179177 DOI: 10.1007/s00228-012-1451-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the pattern of drug consumption among patients with dementia in a geographically defined general population in Catalonia (Spain), and to determine its association with age, gender, type of dementia and severity indicators. METHODS Cross-sectional study that included 1,894 cases of dementia registered by the Registry of Dementias of Girona from 2007 to 2009. Prescribed drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. A descriptive analysis of drug consumption was stratified according to age, gender, dementia subtypes and dementia severity. Binary logistic regression models were adjusted to detect the association of these variables with drug consumption according to the ATC groups. RESULTS The most commonly prescribed drugs were for the central nervous system (CNS) (96.4 %), cardiovascular system (79.4 %) and digestive and metabolic system categories (77.7 %). No significant differences were found between the use of nervous system drugs and age, gender, dementia subtypes or dementia severity. The use of alimentary tract and metabolism related drugs, as well as cardiovascular and blood system drugs, were positively correlated with age and secondary dementia. The prevalence of use of cardiovascular and musculoskeletal drugs was higher in women than in men (OR: 1.34; OR: 1.26 respectively). A negative association was found between the severity of dementia and the use of musculoskeletal drugs (OR: 0.71), while its use was significantly higher in the youngest patients (OR: 1.71). CONCLUSIONS Almost all patients with dementia received a CNS drug, being at risk of inappropriate treatment. Treatment for comorbidities in patients with dementia should not be withheld on the basis of age or dementia severity, but rather on the benefit/risk ratio of its prescription. Further studies are needed to evaluate potentially inappropriate drug use and possible untreated conditions in this population.
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Noia AS, Secoli SR, Duarte YADO, Lebrão ML, Lieber NSR. Fatores associados ao uso de psicotrópicos por idosos residentes no Município de São Paulo. Rev Esc Enferm USP 2012; 46 Spec No:38-43. [DOI: 10.1590/s0080-62342012000700006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/18/2012] [Indexed: 11/22/2022] Open
Abstract
Os objetivos do estudo foram identificar a prevalência e os fatores associados ao uso de psicotrópicos entre os idosos do Município de São Paulo. Trata-se de um estudo transversal, de base populacional, cujos dados foram obtidos do Estudo Saúde, Bem-estar e Envelhecimento. A amostra foi constituída de 1.115 idosos de 65 anos ou mais, os quais foram entrevistados por meio de instrumento padronizado. Na análise dos dados utilizou-se regressão logística univariada e múltipla stepwise forward e nível de significância de 5%. A prevalência de uso de psicotrópicos foi 12,2% e os fatores associados foram sexo feminino (OR=3,04 IC95%=1,76-5,23) e polifarmácia (OR=4,91 IC95%=2,74-8,79). O uso de psicotrópicos por idosos deve ter sua avaliação risco-benefício muito bem estabelecida. Mulheres idosas, especialmente as submetidas à polifarmácia merecem atenção diferenciada, no ajuste posológico e tempo de tratamento, visando à minimização dos desfechos adversos a que estão sujeitas.
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Sterke CS, Ziere G, van Beeck EF, Looman CWN, van der Cammen TJM. Dose-response relationship between selective serotonin re-uptake inhibitors and injurious falls: a study in nursing home residents with dementia. Br J Clin Pharmacol 2012; 73:812-20. [PMID: 22486601 DOI: 10.1111/j.1365-2125.2011.04124.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM The contribution of selective serotonin re-uptake inhibitors (SSRIs) to injurious fall risk in patients with dementia has not been quantified precisely until now. Our objective was to determine whether a dose-response relationship exists for the use of SSRIs and injurious falls in a population of nursing home residents with dementia. METHODS Daily drug use and daily falls were recorded in 248 nursing home residents with dementia from 1 January 2006 until 1 January 2008. For each resident and for each day of the study period, data on drug use were abstracted from the prescription database, and information on falls and subsequent injuries was retrieved from a standardized incident report system, resulting in a dataset of 85,074 person-days. RESULTS We found a significant dose-response relationship between injurious falls and the use of SSRIs. The risk of an injurious fall increased significantly with 31% at 0.25 of the Defined Daily Dose (DDD) of a SSRI, 73% at 0.50 DDD, and 198% at 1.00 DDD (Hazard ratio = 2.98; 95% confidence interval 1.94, 4.57). The risk increased further in combination with a hypnotic or sedative. CONCLUSIONS Even at low doses, SSRIs are associated with increased risk of an injurious fall in nursing home residents with dementia. Higher doses increase the risk further with a three-fold risk at 1.00 DDD. New treatment protocols might be needed that take into account the dose-response relationship between SSRIs and injurious falls.
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Affiliation(s)
- Carolyn S Sterke
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Flick U, Garms-Homolová V, Röhnsch G. "And mostly they have a need for sleeping pills": physicians' views on treatment of sleep disorders with drugs in nursing homes. J Aging Stud 2012; 26:484-94. [PMID: 22939545 DOI: 10.1016/j.jaging.2012.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 06/21/2012] [Accepted: 07/03/2012] [Indexed: 11/16/2022]
Abstract
The percentage of nursing home residents treated with hypnotic medications is high, as many authors report, despite the fact that such medications are almost always associated with undesirable effects for old people. This article takes a closer look at nursing home physicians' views of prescriptions when treating sleep disorders of nursing home residents. How do physicians characterize the treatment strategy for residents suffering from sleep disorders? How do they balance the benefits and risks of the hypnotic medication? Under what circumstances do they accept negative consequences? To answer these questions, N=20 physicians (aged 36 to 68 years) in 16 nursing homes in a German city were interviewed. The physicians were either employed by nursing homes or worked on a contract basis. Comparative categorization of the data produced a typology across cases. Three interpretative patterns concerning the use of drugs for treating sleep disorders were identified--"by request," "ambivalence," and "reflected prescription." Differences between them were determined by the significance of residents' wishes, neglect of risks, particularly that of addiction, and the attempt to balance benefits and disadvantages. The study showed deficits in professional management of sleep disorders in nursing homes.
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Affiliation(s)
- Uwe Flick
- Alice Salomon University of Applied Sciences, Berlin, Germany; University of Vienna, Austria.
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Hill KD, Wee R. Psychotropic drug-induced falls in older people: a review of interventions aimed at reducing the problem. Drugs Aging 2012; 29:15-30. [PMID: 22191720 DOI: 10.2165/11598420-000000000-00000] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Falls are a common health problem for older people, and psychotropic medications have been identified as an important independent fall risk factor. The objective of this paper was to review the literature relating to the effect of psychotropic medications on falls in older people, with a particular focus on evidence supporting minimization of their use to reduce risk of falls. A literature search identified 18 randomized trials meeting the inclusion criteria for the review of effectiveness of psychotropic medication withdrawal studies, including four with falls outcomes. One of these, which targeted reduced psychotropic medication use in the community, reported a 66% reduction in falls, while the other studies demonstrated some success in reducing psychotropic medication use but with mixed effects on falls. Other randomized trials evaluated various approaches to reducing psychotropic medications generally or specific classes of psychotropic medications (e.g. benzodiazepines), but did not report fall-related outcomes. Overall, these studies reported moderate success in reducing psychotropic medication use, and a number reported no or limited worsening of key outcomes such as sleep quality or behavioural difficulties associated with withdrawal of psychotropic medication use. Reduced prescription of psychotropic medications (e.g. seeking non-pharmacological alternatives to their use in place of prescription in the first place or, for those patients for whom these medications are deemed necessary, regular monitoring and efforts to cease use or wean off use over time) needs to be a strong focus in clinical practice for three reasons. Firstly, psychotropic medications are commonly prescribed for older people, both in the community and especially in the residential care setting, and their effectiveness in a number of clinical groups has been questioned. Secondly, there is strong evidence of an association between substantially increased risk of falls and use of a number of psychotropic medications, including benzodiazepines (particularly, the long-acting agents), antidepressants and antipsychotic drugs. Finally, the largest effect of any randomized trial of falls prevention to date was achieved with a single intervention consisting of weaning psychotropic drug users off their medications.
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Affiliation(s)
- Keith D Hill
- Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, VIC, Australia.
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Rolland Y, Andrieu S, Crochard A, Goni S, Hein C, Vellas B. Psychotropic Drug Consumption at Admission and Discharge of Nursing Home Residents. J Am Med Dir Assoc 2012; 13:407.e7-12. [DOI: 10.1016/j.jamda.2011.12.056] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/09/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
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Parsons C, Johnston S, Mathie E, Baron N, Machen I, Amador S, Goodman C. Potentially Inappropriate Prescribing in Older People with Dementia in Care Homes. Drugs Aging 2012; 29:143-55. [DOI: 10.2165/11598560-000000000-00000] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Mann E, Böhmdorfer B, Frühwald T, Roller-Wirnsberger RE, Dovjak P, Dückelmann-Hofer C, Fischer P, Rabady S, Iglseder B. Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wien Klin Wochenschr 2011; 124:160-9. [PMID: 22134410 DOI: 10.1007/s00508-011-0061-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 08/10/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND The practice of inappropriate medication and drug prescription is a major risk factor for adverse drug reactions in geriatric patients and increases the individual, as well as overall, rates of hospital admissions, resulting in increased health care expenditures. A consensus-based list of drugs, generally to be avoided in geriatric patients, is a practical tool to possibly improve the quality of prescribing. OBJECTIVE The aim was to develop a consensus-based list of potentially inappropriate medications (PIM) for geriatric patients in Austria. Local market characteristics and documented prescribing regimens were considered in detail. METHODS A two-round Delphi process involving eight experts in the field of geriatric medicine was undertaken to create a list of potentially inappropriate medications. Using a 5-point Likert scale (from strong agreement to strong disagreement), mean ratings from the experts were evaluated for each drug selected in the first round. The participants were first asked to comment on the potential inappropriateness of a preliminary list of drugs, and to propose alternate substances missing in the previous questionnaire for a second rating process. All drugs whose upper limit of the 95% CI was less than 3.0 were classified as potentially inappropriate. Drugs with a 95% CI enclosing 3.0 entered a second rating by the experts, in addition to other substances suggested during the first questionnaire. Drugs in the second rating were evaluated in comparable fashion to the first one. The final list was synthesized from the results in both rounds. RESULTS Out of a preliminary list of 102 drugs, 61 drugs (59.2%) were classified as potentially inappropriate for geriatric persons in the first Delphi- round. In the second rating, six drugs that were reevaluated, and six drugs proposed additionally, were rated as potentially inappropriate. The final list contains 73 drugs to be avoided in older patients because of an unfavorable benefit/risk profile and/or unproven effectiveness. The list also contains suggestions for therapeutic alternatives and information about pharmacological and pharmacokinetic characteristics of all drugs judged as potentially inappropriate. CONCLUSION The current Austrian list of potentially inappropriate medications may be a helpful tool for clinicians to increase the quality of prescribing in older patients. Like all explicit lists previously published, its validity needs to be proven in validation studies.
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Affiliation(s)
- Eva Mann
- Institute of General Medicine, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
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Abstract
BACKGROUND Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes. METHODS Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP). RESULTS The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61-4.09), insomnia (OR: 1.38; 95% CI: 1.10-1.73), depression (OR: 1.30; 95% CI: 1.03-1.65), and age <80 years (OR: 1.79; 95% CI: 1.38-2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17). CONCLUSION The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.
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Parsons C, Haydock J, Mathie E, Baron N, Machen I, Stevenson E, Amador S, Goodman C. Sedative load of medications prescribed for older people with dementia in care homes. BMC Geriatr 2011; 11:56. [PMID: 21958366 PMCID: PMC3197480 DOI: 10.1186/1471-2318-11-56] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 09/30/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of this study was to determine the sedative load and use of sedative and psychotropic medications among older people with dementia living in (residential) care homes. METHODS Medication data were collected at baseline and at two further time-points for eligible residents of six care homes participating in the EVIDEM-End Of Life (EOL) study for whom medication administration records were available. Regular medications were classified using the Anatomical Therapeutic Chemical classification system and individual sedative loads were calculated using a previously published model. RESULTS At baseline, medication administration records were reviewed for 115 residents; medication records were reviewed for 112 and 105 residents at time-points 2 and 3 respectively. Approximately one-third of residents were not taking any medications with sedative properties at each time-point, while a significant proportion of residents had a low sedative load score of 1 or 2 (54.8%, 59.0% and 57.1% at baseline and time-points 2 and 3 respectively). More than 10% of residents had a high sedative load score (≥ 3) at baseline (12.2%), and this increased to 14.3% at time-points 2 and 3. Approximately two-thirds of residents (66.9%) regularly used one or more psychotropic medication(s). Antidepressants, predominantly selective serotonin re-uptake inhibitors (SSRIs), were most frequently used, while antipsychotics, hypnotics and anxiolytics were less routinely administered. The prevalence of antipsychotic use among residents was 19.0%, lower than has been previously reported for nursing home residents. Throughout the duration of the study, administration of medications recognised as having prominent sedative adverse effects and/or containing sedative components outweighed the regular use of primary sedatives. CONCLUSIONS Sedative load scores were similar throughout the study period for residents with dementia in each of the care homes. Scores were lower than previously reported in studies conducted in long-term care wards which have on-site clinical support. Nevertheless, strategies to optimise drug therapy for care home residents with dementia which rely on clinicians external to the care home for support and medication review are required.
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Affiliation(s)
- Carole Parsons
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK
| | - Jane Haydock
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK
| | - Elspeth Mathie
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Natasha Baron
- General Practice & Primary Care Research Unit, Institute of Public Health, Robinson Way, Cambridge, CB2 0SR, UK
| | - Ina Machen
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Elizabeth Stevenson
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Sarah Amador
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
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